Healthcare Provider Details

I. General information

NPI: 1437440823
Provider Name (Legal Business Name): LISA BUENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 W SEED FARM RD
SACATON AZ
85247
US

IV. Provider business mailing address

15240 N 142ND AVE UNIT 1091
SURPRISE AZ
85379-8759
US

V. Phone/Fax

Practice location:
  • Phone: 602-528-1497
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS009676
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: